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Question 722
Obstetric infection → Viral
Classification
Question
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Management after repeat chickenpox exposure
Question Stem
A non-immune pregnant woman has received a course of antiviral post-exposure prophylaxis following significant chickenpox exposure. Two weeks later she has a new significant exposure and has not seroconverted. What is the most appropriate approach to the new exposure?
Options
A
A second course of antiviral prophylaxis may be prescribed from day 7 after the new exposure
B
No further prophylaxis can be given during the same pregnancy
C
Give varicella vaccination immediately
D
Start intravenous aciclovir on the day of the new exposure
E
Wait until 28 days after the new exposure before considering prophylaxis
Explanation
If a pregnant woman has a further significant exposure to chickenpox and seroconversion has not occurred, a second course of oral antiviral PEP can be prescribed from 7 days after the new exposure. If VZIG rather than antiviral PEP has been used, VZIG can be repeated when the subsequent exposure occurs 3 weeks or more after the previous dose.
Option Validity
B) repeat prophylaxis may be appropriate following a further significant exposure when seroconversion has not occurred.
C) varicella vaccination is not administered during pregnancy.
D) routine PEP uses oral antiviral therapy from day 7 rather than immediate intravenous aciclovir.
E) prophylaxis should not be deferred until day 28.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 4.3.